Adult: As colistin sulfate: 1.5-3 MIU tid. Child: As colistin sulfate: <15 kg: Not suitable; 15-30 kg: 0.75-1.5 MIU tid.
Parenteral Severe Gram-negative infections
Adult: As colistimethate Na (strength expressed in terms of colistin base): 2.5-5 mg/kg/day in 2-4 divided doses. Max: 5 mg/kg/day. Child: As colistimethate Na (strength expressed in terms of colistin base): 2.5 mg/kg/day divided 6-12 hrly.
Renal Impairment
Parenteral:
CrCl (mL/min)
Dosage
10-29
1.5 mg/kg 36hrly.
30-49
2.5 mg/kg/day once daily or in 2 divided doses.
50-79
2.5-3.8 mg/kg/day in 2 divided doses.
≥80
Same as adult dose.
Reconstitution
Reconstitute 150 mg vial w/ 2 mL sterile water for inj. Reconstituted soln provides colistimethate Na at a concentration equivalent to 75 mg/mL colistin base.
Contraindications
Hypersensitivity. Myasthenia gravis.
Special Precautions
Patients w/ renal impairment, porphyria. Pregnancy and lactation.
Adverse Reactions
Superinfection; renal damage; visual disturbances; GI disturbances, dizziness, nausea, vomiting; confusion, peripheral neuropathy; respiratory insufficiency and muscle weakness. Potentially Fatal: Severe colitis.
Patient Counseling Information
Due to neurologic disturbances that may occur, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor serum creatinine and BUN regularly while on treatment.
Overdosage
Symptoms: Signs of neuromuscular blockade e.g. paraesthesia, lethargy, confusion, ataxia, dizziness, apnoea. Possible respiratory arrest and acute renal failure. Management: Supportive treatment and steps to increase elimination rate of colistin e.g. mannitol diuresis, prolonged haemodialysis or peritoneal dialysis.
Description: Mechanism of Action: Colistin is a polymyxin antibiotic which is active against aerobic gram-ve bacteria including most enterobacteria except Proteus, Providentia and Serratia. Susceptible organisms include P. aeruginosa, Legionella spp, H. influenzae, Acinetobacter, V. cholera, Salmonella, Shigella and Pasteurella. It acts as a cationic detergent that causes leaking of intracellular substances and cell death by damaging the bacterial cytoplasmic membrane. Pharmacokinetics: Absorption: Poorly absorbed from the GI tract. Time to peak plasma concentration: 2-3 hr (IM). Distribution: Reversibly bound to body tissues; diffuses across the placenta but negligible into the CSF except in infants. Enters breast milk. Excretion: More rapid in childn than in adults; diminished in patients with renal impairment.
Chemical Structure
Colistin Source: National Center for Biotechnology Information. PubChem Database. Colistin, CID=5311054, https://pubchem.ncbi.nlm.nih.gov/compound/Colistin (accessed on Jan. 22, 2020)
Storage
Store between 20-25°C. Reconstituted soln: Store between 2-8°C.
Anon. Colistin (Colistimethate) . Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/08/2015.Buckingham R (ed). Colistin Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/08/2015.Colistimethate for Injection (JHP Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/08/2015.McEvoy GK, Snow EK, Miller J et al (eds). Colistimethate Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/08/2015.
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